Healthcare Provider Details

I. General information

NPI: 1780471128
Provider Name (Legal Business Name): RESHMA RE KOENIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14021 RANCHERO DR
FONTANA CA
92337-8351
US

IV. Provider business mailing address

14021 RANCHERO DR
FONTANA CA
92337-8351
US

V. Phone/Fax

Practice location:
  • Phone: 951-300-3285
  • Fax:
Mailing address:
  • Phone: 951-300-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95020591
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95020591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: